EFF Sues for Answers About Medicare's AI Experiment

EFF update
6 days 4 hours ago
Little Is Known About AI That Could Affect Millions of Seniors' Care

SAN FRANCISCO – The Electronic Frontier Foundation (EFF) today filed a Freedom of Information Act (FOIA) lawsuit against the Centers for Medicare & Medicaid Services (CMS) seeking records about a multi-state program that is using AI to evaluate requests for medical care.

"Tasking an algorithm with making determinations about treatment can create unwarranted—and even discriminatory—delays or denials of necessary medical care," said Kit Walsh, EFF’s Director of AI and Access-to-Knowledge Legal Projects. "Given these serious risks, the public requires transparency that it hasn't gotten. We're suing to get badly needed answers about how Medicare's AI experiment works."

Announced by CMS Administrator Dr. Mehmet Oz last year, the pilot program known as WISeR (Wasteful and Inappropriate Service Reduction) uses AI to assess prior authorization requests from Medicare beneficiaries. Previously rare in original Medicare, prior authorization requires medical providers to obtain advance approval from a patient’s health insurer before delivering certain treatments or services as a condition of coverage.

Unfortunately, there is little information about how the AI algorithms used in WISeR work, including what training data they rely on. It remains unclear whether WISeR has any safeguards against systemic flaws such as algorithmic bias, privacy violations, and wrongful denials of care.

Healthcare experts, care providers, and lawmakers have all raised alarms that WISeR may cause serious harm to patients by relying on AI unless it has the necessary safeguards. Despite this widespread criticism, WISeR was rolled out in six states in January, potentially affecting as many as 6.4 million Medicare beneficiaries, according to one estimate.

By design, WISeR incentivizes contracted companies to deny prior approval against the best interests of patients. Vendors are compensated, in part, on the volume of healthcare services they deny and are entitled to as much as 20 percent of the associated savings. Just weeks after WISeR's launch, hospitals and other health care providers started reporting delays in care approval, communication gaps, and administrative strain.

Earlier this year, EFF submitted a FOIA request to CMS asking for records related to WISeR. Among other records, the request sought agreements with software vendors participating in WISeR; records related to any tests for accuracy, bias, or hallucinations in vendors' technology; and records related to any audits, monitoring, or evaluation of WISeR and participating vendors. To date, CMS has not provided any of these records to EFF. EFF's FOIA lawsuit asks for their immediate processing and release.

"The public has a right to know more about the algorithms driving decisions around their healthcare," said Tori Noble, Staff Attorney at EFF. "Without greater transparency, patients, providers, and policymakers will continue to be left in the dark.”

EFF thanks Stanford Law School's Juelsgaard Intellectual Property & Innovation Clinic for their help in preparing this lawsuit.

For the complaint: https://www.eff.org/document/complaint-eff-v-cms-medicare-wiser-foia

Tags: transparencyartificial intelligence and machine learningautomated decision-makingContact:  ToriNobleStaff Attorneytori@eff.org
Hudson Hongo

【おすすめ本】鶴見太郎『シオニズム イスラエルと現代世界』━ナショナリズムと植民地主義が複雑に絡み合った動きを辿る＝大治朋子（毎日新聞専門編集委員）

日本ジャーナリストクラブ（JCJ）
6 days 4 hours ago
　イスラエル・パレスチナ紛争の発端であり、その主因のひとつともいわれるシオニズムを、「等身大で精緻に」描写したという本書は、国際社会が直面する課題を浮かび上がらせる一冊だ。　ちまたにはびこる「粗雑な」歴史認識を排し、 語られるべき問題や責任を次々と照らし出す。　13万部の大ベストセラーとなった『ユダヤ人の歴史』（中公新書）の著者である、東京大学大学院准教授・鶴見太郎氏による最新刊である。　著者によると、シオニズムは19世紀終盤のロシア帝国領で生まれた「ユダヤ人の民族的拠点をパ..
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【おすすめ本】鶴見太郎『シオニズム イスラエルと現代世界』━ナショナリズムと植民地主義が複雑に絡み合った動きを辿る＝大治朋子（毎日新聞専門編集委員）

日本ジャーナリストクラブ（JCJ）
6 days 4 hours ago
　イスラエル・パレスチナ紛争の発端であり、その主因のひとつともいわれるシオニズムを、「等身大で精緻に」描写したという本書は、国際社会が直面する課題を浮かび上がらせる一冊だ。　ちまたにはびこる「粗雑な」歴史認識を排し、 語られるべき問題や責任を次々と照らし出す。　13万部の大ベストセラーとなった『ユダヤ人の歴史』（中公新書）の著者である、東京大学大学院准教授・鶴見太郎氏による最新刊である。　著者によると、シオニズムは19世紀終盤のロシア帝国領で生まれた「ユダヤ人の民族的拠点をパ..
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👓 Who's Really Watching What Smartglasses See? | EFFector 38.6

EFF update
6 days 6 hours ago

After years of tech industry experiments, smartglasses with embedded cameras and microphones have finally gone mainstream. And, disturbingly, sometimes it's not just their owners who are watching what these devices record. In this week's EFFector newsletter, we're taking a closer look at the privacy implications of Meta Ray-Bans, and sharing all the latest in the fight for privacy and free speech online.

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Hudson Hongo